2022-05-06T08:06:53-05:00 2021-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2020-07-01 460225414 ST MICHAEL'S HOSPITAL INC STMI 6055892100 410 WEST 16TH AVENUE TYNDALL SD 570662318 ASHLI DANILKO CEO 6055892100 2022-05-03 1 ASHLI DANILKO 999009999 LAURIE HANSON CPA P00851848 6053391999 2022-05-03 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z ASHLI DANILKO 410 WEST 16TH AVENUE TYNDALL SD 570662318 14332504 0 0928 X WWW.AVERA.ORG/ST-MICHAELS X 1966 SD TO PROVIDE HEALTHCARE SERVICES. 7 7 105 12 100528 0 41119 3620296 10082383 10532329 95306 176235 33040 3400 10251848 14332260 48377 20672 0 0 5384165 5862519 0 0 0 4295586 4193835 9728128 10077026 523720 4255234 20425456 22290114 5217323 2136186 15208133 20153928 X IT IS THE MISSION OF ST. MICHAEL'S HOSPITAL TO PROVIDE READILY ACCESSIBLE HEALTH CARE TO THE PEOPLE OF BON HOMME COUNTY AND THE SURROUNDING AREAS. IN KEEPING WITH THE HERITAGE OF THE CATHOLIC CHURCH, ST. MICHAEL'S WILL AIM TO PROMOTE THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL HEALTH OF ALL ITS PATIENTS. THE HEALTH CARE CENTERS WILL CONTINUE TO OFFER QUALITY SERVICES BASED ON COMMUNITY NEEDS AND FISCAL SOLVENCY. 0 0 8235035 20672 10435201 ST. MICHAEL'S HOSPITAL, INC. (SMH) OPERATES A 25-BED CRITICAL ACCESS HOSPITAL WITH PROVIDER BASED RURAL HEALTH CLINICS LOCATED IN TYNDALL AND IN AVON. PROVIDER STAFF, NURSING PERSONNEL, LABORATORY AND RADIOLOGY PERSONNEL ARE AVAILABLE AS NEEDED 24-HOURS A DAY, 7-DAYS A WEEK. DURING THE FISCAL YEAR ENDING JUNE 30, 2021, ACUTE PATIENT DAYS WERE 215 AND SWING-BED DAYS WERE 845.SMH ENGAGED IN DISASTER ASSISTANCE DURING THE YEAR BY PROVIDING A COVID-19 VACCINATION CLINIC. 8235035 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 19 0 1 105 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X X LISA RONKE 6055892100 410 W 16TH AVE TYNDALL SD 570662318 X ASHLI DANILKO CEO BEG SEPT 12 2020 40.00 X 380246 0 46846 CAROL DEURMIER CEO UNTIL SEPT 11 2020 40.00 X 217970 0 35787 DR MELVIN WALLINGA FAMILY PRACTICE PHYSICIAN 28.00 X 206859 0 34384 JACLYN DVORACEK PHARMACY MANAGER 36.00 X 146396 0 32048 JEREMIAH BERTSCHINGER PHARMACIST 40.00 X 137750 0 14905 ANGELA SCHNETZER PA-C 32.00 X 134321 0 5335 TARA SCHAFERS PHARMACIST 40.00 X 133417 0 14516 LISA RONKE DIRECTOR OF FINANCE 40.00 X 64754 0 4161 STEVE JOHNSON CHAIRPERSON 1.00 X X 0 0 0 JOSEPH KOSTAL VICE CHAIRPERSON 1.00 X X 0 0 0 LAURIE JURRENS SECRETARY 1.00 X X 0 0 0 FATHER JOE FORCELLE MEMBER 1.00 X 0 0 0 RICHARD R PIER MEMBER 1.00 X 0 0 0 CONNIE TJEERDSMA MEMBER 1.00 X 0 0 0 AUSTIN KOCH MEMBER 1.00 X 0 0 0 1421713 0 187982 8 0 1 1 AVERA SACRED HEART HOSPITAL 501 SUMMIT YANKTON SD 57078 ADMIN, IT, OTHER SERVICES 696687 AVERA HEALTH 3900 W AVERA DRIVE SIOUX FALLS SD 57108 MEDICAL SERVICES, E SERVICES, OTHER SERV 315742 HAUSMANN & SONS CONTRUCTION 8885 EXECUTIVE WOODS DR LINCOLN NE 68512 CONSTRUCTION SERVICES 284319 AVERA MCKENNAN 1325 S CLIFF AVE SIOUX FALLS SD 57117 MEDICAL SERVICES 187631 A&B STAFFING SOLUTIONS 3451 S MERCY RD STE 102 GILBERT AZ 85297 LOCUMS STAFFING COVERAGE 104578 5 3620046 250 3620296 PATIENT SERVICE FEES 621110 8099455 8099455 RETAIL PHARMACY 446110 2385593 2285065 100528 47281 47281 10532329 176479 176479 3400 0 3400 3400 3400 244 -244 -244 -244 14332260 10435201 100528 176235 20672 20672 425705 425705 72796 72796 4294670 3868994 425676 134785 120046 14739 629090 556862 72228 305473 266812 38661 45960 45960 155506 123689 31817 4434 1864 2570 272904 96797 176107 158761 158761 106158 70276 35882 18246 18097 149 5562 2478 3084 558327 372573 185754 79696 79696 SUPPLIES 2380719 2370193 10526 EQUIPMENT AND MAINTENAN 376381 327835 48546 DUES AND SUBSCRIPTIONS 29069 17847 11222 2112 2112 10077026 8235035 1841991 0 10525115 11003328 903359 1144421 388332 382802 37619 42740 10830012 6701283 3765520 4128729 4565511 5413094 240000 175000 20425456 22290114 672701 710861 3694230 1425325 850392 0 5217323 2136186 X 15186947 20132742 21186 21186 15208133 20153928 20425456 22290114 X 4255234 524878 165683 X 0 1 X 1 0 X 20963 0 20963 20893 70 20963 20763 130 20893 20668 95 20763 20538 130 20668 0.00000 1.00000 0.00000 0 0 5000 34375 39375 6353029 3684707 2668322 4290330 2920649 1369681 147278 95927 51351 4128729 INVESTMENT IN AVERA POOLED FUND 4275970 F INTEREST IN NET ASSETS OF AVERA HEALTH FOUNDATION 1137124 F 5413094 X 15022821 524878 165683 690561 14332260 0 14332260 10077026 0 10077026 0 10077026 PART V, LINE 4: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO PROVIDE FOR CAPITAL NEEDS THAT MAY ARISE. PART X, LINE 2: THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 165,683. 1 1 X 1 X 1 X 1 1 1 0 0 30000 30000 0.00300 279633 226180 53453 0.00530 309633 226180 83453 0.00830 243517 1518 241999 0.02400 11269 1090 10179 0.00100 1859507 1111622 747885 0.07420 12335 12335 0.00120 2126628 1114230 1012398 0.10040 2436261 1340410 1095851 0.10870 525 525 0.00010 657 657 0.00010 1182 1182 0.00020 1 178019 26703 3930873 3888369 42504 X 1 1 1 1 ST MICHAEL'S HOSPITAL INC 410 WEST 16TH AVENUE TYNDALL SD 570660027 WWW.AVERA.ORG/ST-MICHAELS 48584 X X X X ST MICHAEL'S HOSPITAL INC 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V SECTION C X SEE PART V SECTION C X 1 18 1 SEE PART V SECTION C 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X WWW.AVERA.ORG/LOCATIONS/PROFILE/ST-MICHAELS-HOSPITAL-AVERA/ X WWW.AVERA.ORG/LOCATIONS/PROFILE/ST-MICHAELS-HOSPITAL-AVERA/ X WWW.AVERA.ORG/LOCATIONS/PROFILE/ST-MICHAELS-HOSPITAL-AVERA/ X X X X X X 1 X 0 X X X X 1 X 0 0 ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 5: THE HOSPITAL CONSULTED WITH COUNTY COMMUNITY HEALTH SERVICES, NURSES, MEDICAL PROVIDERS, SCHOOL OFFICIALS, BUSINESS LEADERS, RELIGIOUS LEADERS AND COMMUNITY MEMBERS. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 11: PURSUANT TO THE IMPLEMENTATION STRATEGY ADOPTED BY ST. MICHAEL'S HOSPITAL, INC., ALL NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED DURING THE YEAR 2018 WILL BE ADDRESSED.1. IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES AVAILABLE TO OUR COMMUNITY AT A LOCAL LEVEL: IN PARTNERSHIP WITH AVERA ECARE BEHAVIORAL HEALTH, ST. MICHAEL'S HOSPITAL PARTICIPATES IN ETRIAGE SERVICES AND OFFERS VIRTUAL BEHAVIORAL HEALTH APPOINTMENTS VIA TELEMEDICINE TECHNOLOGY. 2. PROMOTE HEALTHY LIFESTYLE CHOICES, PHYSICAL ACTIVITY AND WEIGHT MANAGEMENT: ST. MICHAEL'S HOSPITAL PROVIDES EDUCATION AND HEALTH PROMOTION INITIATIVES TO PROMOTE HEALTHY LIFESTYLE CHOICES, ADDRESS PHYSICAL INACTIVITY AND ENCOURAGE WEIGHT MANAGEMENT. ST.MICHAEL'S HOSPITAL CONTINUES TO OFFER NUTRITIONAL EDUCATION AND WELLNESS CENTER ACTIVITIES AND CLASSES. THE FACILITY COLLABORATES WITH LOCAL REPRESENTATIVES TO PARTICIPATE IN THE HEALTHY HOMETOWN INITIATIVE WITH WELLMARK.SOME OF THE SERVICES PROVIDED WERE LIMITED DUE TO THE COVID 19 PANDEMIC. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY IS UTILIZED AS A LAST RESORT. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 16J: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED IN THE EMERGENCY ROOM, RECEPTION AREA AND WAITING AREAS. STAFF DISCUSS THE AVAILABILITY OF THE FACILITY'S FINANCIAL ASSISTANCE POLICY WITH PATIENTS UPON ADMISSION. NOTICE IS ALSO INCLUDED IN PAYMENT REMINDER LETTERS AND IN STATEMENTS. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. PART V. SECTION B, LINE 7A THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE ATHTTPS://WWW.AVERA.ORG/LOCATIONS/PROFILE/ST-MICHAELS-HOSPITAL-AVERA/ ANDHTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/#MICHAEL PART V. SECTION B, LINE 10A THE IMPLEMENTATION STRATEGY IS AVAILABLE UPON REQUEST AND ATHTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/#MICHAEL 1 1 - BON HOMME FAMILY PRACTICE CLINIC 130 MAIN STREET AVON SD 57315 FAMILY PRACTICE CLINIC PART I, LINE 3C: IN ADDITION TO THE USE OF FPG TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE, SMH ALSO LOOKS AT THE PATIENT'S ASSETS, MEDICAL INDIGENCY, INSURANCE STATUS AND ELIGIBILITY FOR MEDICARE/MEDICAID. BEING IN A RURAL COMMUNITY WITH A SMALL POPULATION, SMH MAY ALSO USE KNOWN INFORMATION OF A PATIENT'S HARDSHIPS IN MAKING THE FINAL DETERMINATION. PRESUMPTIVE ELIGIBILITY IS UTILIZED AS A LAST RESORT. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINE 7B WAS OBTAINED UTILIZING THE MEDICAID AND MEDICARE COST REPORTS. LINES 7E, 7F, AND 7I WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS OBTAINED FROM THE MEDICARE COST REPORT. PART I, LINE 7G: PHYSICIAN CLINIC COSTS ARE INCLUDED IN SUBSIDIZED HEALTH SERVICES. REVENUES OF $654,361 AND COSTS OF $1,358,438 WERE INCLUDED FOR A NET COMMUNITY BENEFIT OF $704,077. PART II, COMMUNITY BUILDING ACTIVITIES: SMH IS INVOLVED WITH THE AREA CHAMBER OF COMMERCE AND ROTARY CLUB. SMH WORKS TO ENHANCE THE QUALITY OF LIFE AND EMPOWER ITS PATIENTS, CARE-GIVERS AND COMMUNITY WITH THE RESOURCES THEY NEED WHEN THEY NEED THEM. SMH ALSO PROVIDES HEALTHCARE CAREER EDUCATION TO PROMOTE HEALTHCARE CAREERS AND RURAL HEALTH. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN 2020. THEREFORE, 15% OF IMPLICIT PRICE CONCESSIONS CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: THE FOOTNOTE THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS ON PAGES 9-10 OF THE ATTACHED AUDITED FINANCIAL STATEMENT. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 6/30/21. MANY PATIENTS IN OUR SERVICE AREA QUALIFY FOR MEDICARE. THE FACILITY PROVIDES SERVICES TO THESE PATIENTS EVEN THOUGH MEDICARE REIMBURSEMENT IS NOT SUFFICIENT TO COVER THE COST OF PROVIDING THIS CARE. PROVIDING SERVICES TO THIS POPULATION PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE NEEDED IN OUR COMMUNITY, THEREBY PROVIDING A BENEFIT TO OUR COMMUNITY. PART III, LINE 9B: SMH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE HOSPITAL DOES NOT PURSUE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. PART VI, LINE 2: IN ORDER TO DETERMINE NEEDS OF THE COMMUNITY WE SERVE, ST. MICHAEL'S HOSPITAL CONDUCTS PATIENT SURVEYS VIA TELEPHONE THROUGH HEALTHSTREAMS, AND OUR PROVIDERS HAVE MONTHLY MEETINGS FOR CLINIC AND MEDICAL STAFF AT WHICH TIME MAY DISCUSS NEEDS THAT ARE IDENTIFIED THROUGH THE SURVEYS AND THROUGH OFFICE VISITS. PART VI, LINE 3: THE SMH STAFF ASSISTS PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BY DISCUSSING THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTING THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS WHERE APPLICABLE. THE PROGRAMS ARE DISCUSSED AT THE TIME OF ADMISSION AND PATIENT REQUEST. POSTERS HIGHLIGHTING VARIOUS ASSISTANCE OPTIONS (I.E. ALL WOMEN COUNT) ARE POSTED IN THE ADMISSION AREA. SMH STAFF ALSO DISCUSS THE AVAILABILITY OF ITS CHARITY CARE POLICY WITH PATIENTS UPON ADMISSION. PART VI, LINE 4: SMH SERVES A RURAL POPULATION IN BON HOMME COUNTY WHICH INCLUDES THE CITIES OF TYNDALL, AVON, TABOR AND SPRINGFIELD. THERE IS ONE OTHER HOSPITAL IN BON HOMME COUNTY LOCATED IN SCOTLAND. THE 2020 CENSUS FOR BON HOMME COUNTY REPORTED 7003 PEOPLE WITH 15% OF THE POPULATION AT 100% POVERTY OR BELOW. 20.8% OF BON HOMME COUNTY'S POPULATION IS AGE 65 OR OLDER (COMPARED TO 17.2%) IN THE STATE OF SOUTH DAKOTA. PART VI, LINE 5: SMH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN BON HOMME COUNTY WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. SMH APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE AND PROVIDES READILY ACCESSIBLE HEALTH CARE TO THE PEOPLE OF BON HOMME COUNTY AND THE SURROUNDING AREA.SMH PROVIDES A VARIETY OF COMMUNITY BENEFIT HEALTH ACTIVITIES AT NO COST OR LESS THAN COST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, NUTRITION EDUCATION, FOOT CLINICS, CPR CLASSES, AND BLOOD PRESSURE SCREENINGS. A VARIETY OF PROGRAMS ARE PROVIDED AT NO CHARGE FOR THE CHILDREN IN OUR COMMUNITIES SUCH AS THE IMPACT CONCUSSION PROGRAM, FLU SHOT CLINICS, AND ATHLETIC SCREENINGS. SMH ALSO PROVIDES ATHLETIC PHYSICALS FOR STUDENTS AT A DISCOUNTED RATE. SMH PROVIDES A NURSE ON AN AS NEEDED BASIS FOR AMBULANCE TRANSFERS AT NO COST TO THE LOCAL AMBULANCE SERVICE. APPROXIMATELY 6 CLIENTS WERE SERVED DURING THE FISCAL YEAR ENDED 6/30/21 FOR AMBULANCE TRIPS.SMH PROVIDED FINANCIAL AND IN KIND DONATIONS FOR VARIOUS COMMUNITY NEEDS SUCH AS MEETING ROOM AVAILABILITY, MEDICAL STAFF COVERAGE AT LOCAL SPORTING EVENTS, AND HEALTH EDUCATION, INCLUDING HEALTH PROFESSION EDUCATION FOR STUDENTS GOING INTO THE HEALTHCARE FIELD. SOME OF THESE ACTIVITIES WERE LIMITED IN FY2021 DUE TO THE COVID-19 PANDEMIC.SMH PROVIDES EMERGENCY SERVICES 24-HOURS A DAY, 7-DAYS A WEEK. IN ADDITION TO NURSING STAFF, A MIDLEVEL PROVIDER AND/OR PHYSICIAN ARE IN HOUSE OR ON CALL AT ALL TIMES TO PROVIDE CARE TO ANYONE PRESENTING WITH AN EMERGENT CONDITION REGARDLESS OF THEIR ABILITY TO PAY. FOR FISCAL YEAR ENDED 6/30/21, THERE WERE 730 PATIENTS WHO RECEIVED EMERGENCY CARE AT SMH. SMH ALSO MAKES AVAILABLE E-EMERGENCY SERVICES THROUGH AN ARRANGEMENT WITH AVERA HEALTH WHEREBY EMERGENCY PHYSICIANS AND OTHER SPECIALISTS ARE AVAILABLE VIA VIDEO CONFERENCING TO ASSIST THE MEDICAL STAFF AND NURSES WITH PATIENTS PRESENTING TO THE SMH EMERGENCY ROOM. THE E-EMERGENCY SERVICES ARE PROVIDED AT NO COST TO THE PATIENT. 63 PATIENTS BENEFITED FROM THE E-EMERGENCY SERVICES DURING THE FISCAL YEAR ENDED 6/30/2021. PART VI, LINE 6: SMH IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND THE HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY THE HOSPITAL. SMH ALSO HAS ACCESS TO "BACK OFFICE" SUPPORT SERVICES, SUCH AS LEGAL CONSULTATION, QUALITY BENCHMARKING, CODING, COMPUTER SERVICES, CONTRACT NEGOTIATIONS, ADMINISTRATIVE CONSULTATION, GROUP PURCHASING, HUMAN RESOURCES ASSISTANCE AND MANY OTHER SERVICES. AVERA HEALTH IS ABLE TO PROVIDE THESE SERVICES TO SMH AT A COST BELOW THAT WHICH THE HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT CARE. AVERA HEALTH AND SMH DEDICATE RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE. THESE ACTIVITIES INCLUDE LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS IN THE COMMUNITY, CONTRIBUTIONS TO NONPROFIT COMMUNITY ORGANIZATIONS, NONPROFIT EVENT SPONSORSHIPS, DONATED MEDICAL SUPPLIES, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH SCREENINGS, FLU-SHOT CLINICS, COMMUNITY HEALTH EDUCATION AND VARIOUS OTHER ACTIVITIES. X X X 0 0 0 0 0 0 0 0 0 ASHLI DANILKO CEO BEG SEPT 12 2020 145007 0 0 0 235239 0 14250 0 33745 0 428241 0 0 0 CAROL DEURMIER CEO UNTIL SEPT 11 2020 211435 0 0 0 6535 0 10984 0 26031 0 254985 0 0 0 DR MELVIN WALLINGA FAMILY PRACTICE PHYSICIAN 204527 0 0 0 2332 0 8514 0 25870 0 241243 0 0 0 JACLYN DVORACEK PHARMACY MANAGER 146228 0 0 0 168 0 6178 0 25870 0 178444 0 0 0 JEREMIAH BERTSCHINGER PHARMACIST 137600 0 0 0 150 0 5837 0 9068 0 152655 0 0 0 SCHEDULE J LINE 3 CAROL DEURMIER, CEO UNTIL SEPTEMBER 2020, AND ASHLI DANILKO, CEO BEGINNING SEPTEMBER 2020, ARE COMPENSATED THROUGH AN ARRANGEMENT WITH AVERA SACRED HEART HOSPITAL, 501 SUMMIT STREET, YANKTON, SD 57078. COMPENSATION REPORTED FOR ASHLI DANILKO INCLUDES COMPENSATION FROM AVERA SACRED HEART HOSPITAL (ASHH) FOR HER SERVICES WITH ASHH JANUARY 1 THROUGH JULY 11, 2020. MS. DANILKO RECEIVED A SEPARATION PAYMENT FROM ASHH, AND WAS REHIRED SEPTEMBER 20, 2020 TO FILL THE ROLE OF CEO FOR SMH. CHAD JENSEN BROTHER OF CEO 72796 EMPLOYEE WAGES 0 FORM 990, PART VI, SECTION A, LINE 8B THE BOARD OF DIRECTOR COMMITTEES ARE ADVISORY IN NATURE ONLY AND DO NOT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO REVIEW THE 990. THE 990 IS THEN PROVIDED TO EACH BOARD MEMBER FOR THEIR REVIEW PRIOR TO THE ACTUAL FILING OF THE 990. FORM 990, PART VI, SECTION B, LINE 12C ST. MICHAEL'S HOSPITAL CONFLICT OF INTEREST POLICY COVERS ANY DIRECTOR/TRUSTEE, OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS, MEMBER OF MANAGEMENT WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, CEO AND CFO AS WELL AS THEIR FAMILY MEMBERS. SMH REQUIRES ANY DIRECTOR/TRUSTEE, BOARD COMMITTEE MEMBER, OFFICER AND MEMBER OF MANAGEMENT TO DISCLOSE THE EXISTENCE OF A FINANCIAL INTEREST, OTHER ACTUAL OR POSSIBLE CONFLICT OF INTEREST AND ALL MATERIAL FACTS ANNUALLY BY COMPLETING A DISCLOSURE STATEMENT; AND IF A CONFLICT OF INTEREST ARISES AFTER THE COMPLETION OF THE ANNUAL DISCLOSURE, AT THE TIME THE NEW CONFLICT ARISES. THE BOARD OF DIRECTORS MAKES THE DETERMINATION AS TO WHETHER A CONFLICT OF INTEREST EXISTS. THE BOARD OF DIRECTORS ADDRESSES CONFLICT OF INTERESTS VIA A FORMALIZED PROCEDURE. THIS PROCEDURE MAY INCLUDE A PRESENTATION BY THE INTERESTED PERSON, BUT EXCLUDES THE INTERESTED PERSON FROM FURTHER DISCUSSION OR VOTING ON THE TRANSACTION OR ARRANGEMENT THAT MAY CONSTITUTE A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS ALSO INCLUDE A STANDING AGENDA ITEM AT THE BEGINNING OF EACH MEETING WHICH REQUIRES THE DISCLOSURE OF POTENTIAL CONFLICT OF INTEREST FOR ANY ITEMS INCLUDED ON THE AGENDA. FORM 990, PART VI, SECTION B, LINE 15 AVERA SACRED HEART HEALTH SERVICES AND SMH'S BOARD OF DIRECTORS USE COMPARABILITY DATA TO DETERMINE APPROPRIATE COMPENSATION OF THE CEO BASED ON EXPERIENCE AND PERFORMANCE. THE COMPENSATION AMOUNT IS APPROVED ANNUALLY BY THE BOARD OF DIRECTORS. THE CEO DETERMINES THE COMPENSATION FOR OTHER MEMBERS OF MANAGEMENT INCLUDING THE CFO BASED ON AN ANNUAL PERFORMANCE APPRAISAL AND USE OF COMPARABILITY DATA. FORM 990, PART VI, SECTION C, LINE 19 THE FACILITY MAKES THE CONFLICT OF INTEREST POLICY AND BYLAWS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. FORM 990, PART VII, LINE 1A CAROL DEURMIER RETIRED AS CEO ON SEPTEMBER 11, 2020. ON SEPTEMBER 12, 2020, ASHLI DANILKO BECAME THE CEO. PRIOR TO BECOMING CEO, ASHLI WORKED FOR AVERA SACRED HEART HEALTH SERVICES (ASHHS) UNTIL JULY 11, 2020. THAT BEING THE CASE, ASHLI'S COMPENSATION REPORTED IN PART VII INCLUDES COMPENSATION WITH ASHHS THAT RELATES TO WORK THAT WAS PERFORMED BEFORE BECOMING CEO OF ST. MICHAEL'S HOSPITAL. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF AVERA HEALTH FOUNDATION 165,683.